Provider Demographics
NPI:1023519634
Name:WHITWORTH, THOMAS H (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:WHITWORTH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 ROANOKE RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3803
Mailing Address - Country:US
Mailing Address - Phone:706-298-6460
Mailing Address - Fax:706-298-6461
Practice Address - Street 1:1704 ROANOKE RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3803
Practice Address - Country:US
Practice Address - Phone:706-298-6460
Practice Address - Fax:706-298-6461
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist